Individual
MILES ELLSWORTH RANCK IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
6720 W OVERLAND RD, BOISE, ID 83709-2032
(208) 323-1440
(208) 323-1444
Mailing address
6720 W OVERLAND RD, BOISE, ID 83709-2032
(208) 323-1440
(208) 323-1444
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA937
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010031451
REGENCE BLUE SHIELD OF ID
ID
01
—
C2409
BLUE CROSS OF IDAHO
ID
Enumeration date
09/20/2006
Last updated
07/08/2007
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